Doctor's Note

This will look familiar to those who’ve seen my 2012 presentation (either live or vicariously at Uprooting the Leading Causes of Death). Tomorrow I cover the wild finding about meat’s affect on weight in Meat and Weight Gain in the PANACEA Study. Note the caloric expenditure equivalencies I present here are assuming no dietary compensation, something seen quite dramatically, for example, in nut consumption in Testing the Dietary Compensation Theory. Given how hard it is to work off food, let’s make our calories count by choosing the most nutrient dense foods. Calculate Your Healthy Eating Score may be a good place to start.

For further context, check out my associated blog posts: Treadmill Desks: Stand Up For HealthBest Nutrition Bang for Your Buck; and Diet vs. Exercise: What’s More Important?

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  • This will look familiar to those who’ve seen my 2012 presentation (either live or vicariously at Uprooting the Leading Causes of Death). Tomorrow I cover the wild finding about meat and weight gain. Note the caloric expenditure equivalencies I present here are assuming no dietary compensation, something seen quite dramatically, for example, in nut consumption. Given how hard it is to work off food, let’s make our calories count by choosing the most nutrient dense foods. Calculate Your Healthy Eating Score may be a good place to start.

    In the meantime, please feel free to subscribe to my upcoming videos (for free) by clicking here.

    • Rathatcher

      Thanks so much for laboring away on Labor day (and every day). We never miss any of your daily videos. Do you have any videos with tips for old farts taking up exercise after many years…all the plant-strong videos seem geared for triatheletes.

       I will still take my slow jog, but definitely pass on the BBQ where we’re playing music today.

      • HemoDynamic, M.D.

        Besides being a family physician I was also a certified personal trainer with ACE (American Council on Exercise) many years ago, so I will give you my recommendations on exercise for the “Old Farts”
        ;-}

        Walking is a safe, easy and powerful form of exercise that has been shown to increase bone density (strengthen you bones) and reduce cognitive decline (Lower risk of dementia).

        Also, after the bone building cardiovascular exercise (walking or jogging–biking doesn’t seem to have much benefit for keeping the bones in the back strong) a weight training circuit that can be found at many gyms, will help keep your upper body muscles and bones strong as well. 

        You do not need to lift heavy.  In fact lifting weights that you can do 20 to 30 reps to failure 2 to 3 times (sets) will reduce your risk for injury, strengthen you muscles and bones and have cardiovascular benefits as well.

        I hope this helps.

        •  Great points!

          • HemoDynamic, M.D.

            ;-}

    • HemoDynamic, M.D.

      I love that phrase, “Nutrient Dense.”

      Reminds me of something Steven Wright would say:

      “If I ate something that was Nutrient Dense, would that make me stupid?”

      ;-}

  • This is interesting, but it doesn’t discuss the psychogical factors. I eat a reasonable vegan diet, but increase my exercise when I feel that I’m putting on weight. I find that when I focus on limiting my food intake, I become obsessed with food and end up eating even more!

  • LouiseF

    Thanks for working Labor Day, Dr. Greger.
     I’m pleased to report that the Republican National Convention in Tampa provided a catered vegetarian option for lunch and dinner to their staff of communication volunteers in Tampa.  No need to dip into my stash of 20 power bars I had brought with me. Times are changing.
    Louise F

    •  LOL, I also tend to bring my own food. Great to hear that vegetarian options are becoming more common. Now let’s hope for the same for vegan options.

  • Thanks for the information on diet vs. exercise for weight loss. I feel that a lot of weight loss programs allow for a lot of unhealthy calories thinking that you can undo the harm with exercise. I feel like the only way to have permanent weight loss is a diet predominantly of plant foods. I’ve set up a website trying to teach people the health benefits of a plant centered diet. http://www.normashealthyliving.com

  • I have experienced trying to lose weight mostly by diet and mostly by exercise.  I think this post is misleading.  When I tried to lose weight by mostly dieting, I found that I had to *severely* limit how much I was eating.  Just dieting only would make me lose perhaps 30 pounds and then I would easily gain the weight back. Once I started to bicycle everyday, I found that I could lose weight without starving myself and that I would lose weight consuming up to 3000 calories a day.  I am sure that when I was mostly dieting, I was consuming less than 2000 calories.  I lost 95 pounds mostly by exercise, with some dietary moderation, and have kept off every pound. I know a man who is completely sedentary and he had to consume 1000 calories a day to lose weight.  I was exercising perhaps 90 minutes a day and was able to consume about 6 candy bars worth of calories than he could and still lose weight.  Look at this study, which showed that persons who exercised and burned 500 more calories but did not compensate or increase their caloric intake by 500 calories lost just as much weight than the dieters who cut 500 calories from their diet.   The persons who exercised without compensation also had better health outcomes, such as much greater loss of visceral fat and better results on systemic insulin resistance.  The dieters also lost muscle mass, whereas the exercisers did not.  Most of the people got it right, the the so called experts are absolutely and completely wrong- most weight loss and exercise studies do not have equal calorie deficits, for instance most studies comparing dieters and exercisers have the dieters cutting about 700 calories whereas the exercisers are burning 200 calories.  This study has equal calorie deficits.  http://www.sportsnutritionworkshop.com/Files/46.SPNT.pdf  Also, it might be that it is easier for someone to diet if they are not in shape.  However, as someone who is in shape, I would rather exercise than cut calories- of course eat healthy.  Another thing to consider is that is difficult to meet one’s nutritional needs when there is severe calorie restriction necessitated by taking a just diet approach.  It is easier to meet a person’s nutritional needs on 3000 calories than 1000- esp if one is Vegan.  A low calorie Vegan diet cannot meet a person’s protein needs- esp when you consider that 440 calories of beans and rice only yields 20 grams of protein.  A Vegan could easily meet their protein requirement on 3000 calories.  I now consume 3500 calories and don’t gain weight- I would if I stopped exercising.  Also, persons doing Neal Barnard’s diet without exercise usually have lower HDL than if they were exercising.  It is best to exercise a lot and eat a less calorie restricted Vegan diet for weight loss.

    • Veganrunner

      Congrats Dan! I absolutely love hearing success stories. Losing weight is so difficult.

    •  Good points, Dan.  Doug Graham says “you have to be fit enough to be well nourished”, which gets to your point about needing a certain quantity of food.  But I have also dropped 10 pounds in a week, legitimately, with a few hours of  spinning classes, lifting classes, and rowing a day, and about 1500 calories a day of smoothies and salad…there are lots of ways to succeed, but vegan and nutrient dense are the keys.

      •  Since losing the weight, I have worked on making my diet more and more nutrient dense as well as Vegan.  My diet wasn’t terrible while I was losing weight, but it is better now.  This has made the weight maintenance much easier to do and I have lost a little more weight even though I haven’t cut my calorie intake or increased my exercise.  I got down to 160 at 6 foot and my weight has crept down to 158. Also, at almost 52, I have to take a greater number of steps than when I was a teenager.  At that time either just dieting or just exercising would work.  Neither one works by itself anymore, that is why I think the “people” were right to say we need to do both.  We really need to be serious about both.  Exercise does reduce the need for “dieting,” which means calorie restriction, but does not reduce the need for good Vegan nutrition.  “Dieting” is often confused with “good nutrition.”  Also, consuming almost 3000 calories a day made my weight loss a bit slower than yours at 1500- perhaps about a pound a week.  Doing a lot of exercise, a nutrient dense Vegan diet as well as consuming the right number of calories together should stack the deck against excess weight, as well as weight regain.

  • Pacific7

    Great info as usual, but am a little confused.  In a quick read, it would seem to me that the research was talking about resting energy expenditure (basal metabolic rate), not exercise as such. 

    “Unfortunately, the energy balance equation suggests that energy intake and energy expenditure occupy equivalent roles in determining energy balance, when in fact the factors governing energy intakes influence the energy balance far more
    powerfully than the factors determining resting energy expenditure.”

    Also “Energy Balance = Energy Intake – Energy Expenditure.”  It would seem to me that Energy Expenditure would seem to mean calories lost in exercise, basal metabolism (or resting energy), and the thermic effect of food. 

    Again, I’m not sure I see any assertion in the research about exercise. Please set me straight.  Thanks!  
      

  • Ruth Heidrich

    Even while training for the Ironman Triathlon, I could still eat more than I could burn, although I do recommend the nutrient-dense, low-fat vegan diet whether you exercise or not. Exercise is important, however, to maintain lean body mass, muscle strength, and bone density. More on http://www.ruthheidrich.com and my 3 books.

    •  The Ruth Heidrich herself? If so, I’m a big fan and you’re one amazing and inspirational person!

      I’m supposed to do my first half-marathon in October. I never knew one could get so many injuries in such a non-violent sport, LOL.

    • Veganrunner

      And let’s not forget the positive contribution cardio makes to the cardiovascular system.

    • HemoDynamic, M.D.

      Ruth,
      You have been such a great inspiration to so many but especially my breast cancer patients.  You are a pillar of strength that my patients rely on when they don’t think they can change to a plant based diet.
      A sincere and heartfelt thank you from me and all my patients!

      Thanks for posting your website!  You have a lot of fantastic information that everyone should take the time to read!

  • HemoDynamic, M.D.

    Would the real Ronald McDonald please stand up.  Oh, he can’t!

    He never believed that diet was most important!

  • Mike Quinoa

    Hi Dr. Greger,

    So glad you’re coming up again for the Toronto Vegetarian Food Festival this weekend. Your presentation is always so well-received. I hear Colleen Patrick-Goudreau will be in town as well (I better take a defibrillator with me).

  • NutritionFacts is the one-two punch of educational and entertaining.  Thanks for doing what you do!

  • Thissal

    Experience has shown me I have to also exercise if I want to lose weight while dieting.   For starters, it decreases my appetite and cravings.  For another, it speeds up my resting metabolism.   It’s not as simple as saying someone has to run an extra 700 yards to work off an extra butter scoop, which may be true, but it’s missing the main point.

  • Don’t forget the high you get after a good workout (not simply walking; that’s almost useless IMO). Scott Jurek speculates that the reason there’s a high ratio of former drug addicts in ultramarathon running is that you get such a high.

    • Veganrunner

      I sure enjoyed his book. Good vegan recipes too.

  • Valnaples

    Yes, THANK you for working to help us be healthier by posting this on Labor Day, Doc!  So, would it be safe to say that you can run till the cows come home, which would burn the fried chicken CALORIES, but won’t do a thing to help your arteries? 

  • brucegr

    Anecdotes abound re this topic. Here’s another.

    Light to moderate exercise helps flush stress hormones, stabilize blood sugar, etc. It therefore can help curb unhealthy food cravings in addition to oxidizing Calories. Heavier exercise can cause dis-stress and stimulate appetite. I find there’s an exercise threshold if I pass, stimulates my appetite resulting in less wt loss, if any. i.e. When I cycle >400km/wk, or do a lot of higher intensity intervals, I don’t lose weight. If I cycle 150-250km at a moderate pace, I do. Higher exercise load makes me really hungry.

    Now here’s the kicker. I recently did a 10 day meditation retreat. I had two meals a day and 1-2 pieces of fruit for evening meal, all vegan. My daily Calorie intake averaged 1000, despite my REE being 1700. I felt quite satiated on 1000 Cals. Stilling my mind and emotions had a more powerful effect on my appetite and Calorie deficit than any combo of restrictive food intake and exercise I’ve done in the past. Further, while on the retreat, I seemed to lose more visceral fat than lean tissue. When I exercise, cycle, I lose a higher % of lean tissue.

    In my view, science needs to research more seriously the psychoemotional inputs into food cravings. There’s no doubt adrenalin, cortisol, GH, pancreatic function are all heavily influenced by distress. I think there’s a very strong hypothesis the reason advanced nations are obese is minds and emotions are overstimulated and dis-stressed. We have forgotten what life balance is. We have forgotten what it is to value mastering the mind and emotions. Instead, we are slaves to them, and the unbalanced cravings and appetites that accompany them. 

    I hope in 5 years, the question won’t be diet vs exercise, but diet vs calming the mind and emotions.

  • Shiri

    Hi, I couldn’t find any guidelines for what to eat after a run (short runs of 5-6Miles).
    I used to run in the mornings and eat fruit (this is my normal breakfast) and my dietitian told me to add yogurt, since I need protein after exercise.
    Do you have any recombination for vegan breakfast after a run?

    • My recommendation is to find a different dietitian. Your fruit breakfast is a great one!

    • Having protein quickly after (hard) workouts is supposed to help with recovery. You could have rice with beans for example but there are lots of other vegan things high in protein too.

      However this would only matter if you train hard. If it’s more recreational running I would not care about the protein intake for recovery because you probably don’t have problems to recover from easy jogging anyways.

  • Don

    “EXERCISE”, along with a proper diet is an absolute must for healthy life. Without exercise, death is right around the corner.

  • Deana

    Good point! Of course, exercise is important. I don’t think the message here is contradicting that- but you can eat more in 5 minutes than you can burn in 3 hours of exercise. So don’t take your daily 30 minutes of cardio as license to pig out! Thanks for the reminder. I have just discovered your site and LOVE it!

  • 700 yards is .4 miles.

  • I am not sure if I got the message right: “The energy balance equation holds true, but one needs to exercise more to compensate a certain amount of calories than most people think.” Is that the point?

  • Barton van Buskirk

    your body will tell you what it needs stop killing it and listen to it…;

  • Amanda King

    I follow a strict vegan diet and exercise regularly! My weight is always stable and feel so much fitter since abstaining from any animal products! A healthier approach to food is better than a diet for a few weeks! Also exercise is essential to regulating weight!

    • Exercise is important to maintain your health but it is not necessary to maintain a healthy weight. Jeff Novick RD does the best job of discussing the relationship of exercise to calorie density in his DVD Calorie Density: How to Eat More Weigh Less and Live Longer. I have patients with disabilities which limit their exercise. I also see alot of “healthy” lean folks who exercise alot and can maintain their desired weight while eating more calorie dense foods including animal products. The only diet that works long term is the “ad libitum diet” of eating the correct foods when you are hungry. The whole food plant based diet is also consistent with our design as “Hind gut fermenting herbivores”. Congratulations of following a vegan diet and exercise. As I’m sure you have found it has been an interesting journey especially as new science keeps coming out. So keep tuned to NutritionFacts.org. You might also be interested in John McDougall’s article, Sick Vegans, in his Oct 2002, newsletter available for free on his website.

  • ReluctantVegan

    The link to Flatt JP. Issues and misconceptions about obesity. Obesity (Silver Spring). 2011 Apr;19(4):676-86 no longer goes to the abstract.

    • Joseph Gonzales R.D.

      Thank you we’ll update it!

      • Louise filkins

        Hi Joseph! You are very qualified coming from PCRM. I now often eat beans in morning because of you! Thanks for what you do.

  • val

    EXCELLENT…way to go Doc!!!

  • John Coleman
  • Hannah

    Over the past year I have gradually switched to a vegetarian and now mostly plant-based diet, with hopes of simply improving quality of life and increasing longevity. I always eat when I’m hungry, eat until I’m full, and exercise moderately almost every day of the week. I have lost 15 lbs without trying, but unfortunately, do not have any weight to lose and am now underweight. Do you have any suggestions how to maintain weight on a plant-based diet while still eating well and until satisfied?

    Thanks for your time!

    • NatureLover

      I had the same issue. Try doing more weights and less cardio. I find my appetite increases either way. My appetite increase leads me to eat more food than the calories i burned, so it’s basically a moderate form of “bulking”. I have gained a pound per month on moderate lifting, and i see increases in muscle mass while marinating fat. Try increasing foods that are higher in calories, like colored potatoes, plantains, bananas, whole grains. Smoothies are a good way to get in a lot of calories in a shorter time. Eat nuts or seeds every day. Try typing every meal with something: nutritional yeast, avocado, sauce, ground flax seeds. Check out Dr Greger’s app Daily Dozen and use it to gradually increase the amount of food you eat.

  • Bud Kelly

    At the gym, on the treadmill set for 4 mph, I notice the caloric output at 405 kilocalories per hour. Since burning one pound of fat requires a caloric output of over 3,600 kilocalories, that means I’d have to power walk for 9 hours, 36 miles, to burn a pound off. Even if I could do that, I’d end up starved and eat most of it right back on before I got home. (Which would probably be by ambulance.) Geez, I wish my car was so efficient, to go for 9 hours on a single pound (less than a pint) of fuel. That would be over 36 x 8 = 288 mpg.

  • Taylor Cowie3

    Informative piece – I am thankful for the info , Does anyone know if my company could possibly obtain a sample My Life Planning Workbook example to work with ?

  • Kelly

    Hello, my name is Kelly and I have had weight challenges all my life. I’m 48 yrs old, 5 foot 6 inches and weigh 105-110lbs. My A1c and LPA’s have been poor to say the least. I have started the plant based diet to improve my numbers. My problem is loosing weight. I can’t find anything on your site about those who have the opposite problem. Before you ask, my thyroid is fine, has been checked yearly for over 20yrs and I’ve had an uptake scan, all normal. I’m an avid hiker and just got back from hiking 4 fourteeners in Colorado in 3 days, at the same time I lost 6 lbs despite feeding my face. Is there anyone out there that has some ideas??

    • Thea

      Kelly: Below is the standard advice I have for weight gain. Not too many people get back to me on this question, so I’m not sure how much it helps. If you give it a try, let us know what happens. :-)
      .
      —————————-
      As explained in this video: http://nutritionfacts.org/video/eating-more-to-weigh-less, the key to healthy long term weight loss is understanding calorie density and eating low calorie-dense foods. When applied in reverse, the concept of calorie density can be used to gain weight. In general, you would want to eat more foods that are more calorie dense. This includes nuts, but includes a lot of other foods too. The idea is to not just add a single one of these foods, but to add several foods into your diet until the amount of calories you take in exceed your energy needs. Examples of higher calorie dense foods appropriate for a whole plant food diet include: nuts, dried fruits, tofu, avocados, olives, and breads/crackers/dry goods. Also, eat more cooked foods compared to raw foods.
      .
      While the following article is focused on weight loss, you could use the information in reverse for weight gain (or if your goal is just weight maintenance, follow these ideas): http://www.jeffnovick.com/RD/Articles/Entries/2012/5/20_A_Common_Sense_Approach_To_Sound_Nutrition.html and http://www.forksoverknives.com/the-calorie-density-approach-to-nutrition-and-lifelong-weight-management/
      .
      The idea/point is: don’t just add a snack and junk food like ice cream. Incorporate several of these relatively healthy foods and cooked food in general in each meal and snack. For example, while a person wanting to lose weight would ideally use a vegetable-based sauce, you would use a nut-based sauce. While a person wanting to lose or maintain weight would include a whole lot of raw food, say big salads with some lemon juice as the dressing, you might eat smaller amounts of raw food and far more cooked veggies, beans, and grains proportionately.
      .
      While that’s the answer to your actual question, I would step back and ask, “Why do you want to gain weight?” Are you hoping to gain more fat? If so, why? Gaining fat doesn’t seem healthy to me unless you are severely fat deficient. On the other hand, if you want to gain more weight without gaining (too much) fat, then what you are really talking about is gaining muscle. Gaining muscle is a good goal. (From what I’ve read: All else being equal, having more muscle is healthier.) But gaining muscle is more than just changing your diet. Gaining muscle requires certain types of exercise (along with adequate healthy calories). That’s beyond the scope of this site. I just bring it up so you can think about what your real goal is and what it would take to accomplish it.
      .
      Dr. McDougall has a great article on the topic of gaining weight. It will provide some additional perspective as well as maybe some additional ideas. http://www.nealhendrickson.com/mcdougall/030700puhowdoIgainweight.htm
      .
      Hope this helps.